The present embodiments relate generally to medical devices, and more particularly, to apparatus and methods for coupling a graft member to tissue, closing a bodily opening, and the like.
Perforations in tissue or bodily walls may be formed intentionally or unintentionally. For example, an unintentional ventral abdominal hernia may be formed in the abdominal wall due to heavy lifting, coughing, strain imposed during a bowel movement or urination, fluid in the abdominal cavity, or other reasons. Intentional perforations may be formed, for example, during surgical procedures such as translumenal procedures. In a translumenal procedure, one or more instruments, such as an endoscope, may be inserted through a visceral wall, such as the stomach wall. During a translumenal procedure, a closure instrument may be used to close the perforation in the visceral wall. Depending on the structure comprising the perforation, it may be difficult to adequately close the perforation and prevent leakage of bodily fluids.
Attempts to seal perforations have been attempted by coupling a graft member to tissue. For example, during hernia repair, a graft material such as a mesh or patch may be disposed to cover the perforation. The graft material may completely overlap with the perforation, and the edges of the graft material may at least partially overlap with tissue surrounding the perforation. The graft material then may be secured to the surrounding tissue in an attempt to effectively cover and seal the perforation.
In order to secure the graft material to the surrounding tissue, sutures commonly are manually threaded through the full thickness of the surrounding tissue. In the case of a ventral abdominal hernia, the sutures may be threaded through the thickness of the abdominal wall, then tied down and knotted. However, such manual suturing techniques may be time consuming and/or difficult to perform.
In addition to covering and sealing perforations, there are various other instances in which it may be desirable to couple a graft material to tissue. For example, it may become necessary or desirable to couple the graft material to a region of tissue for purposes of reconstructing the local tissue. Whether a graft material is coupled to tissue to reconstruct local tissue, seal a perforation, or another purpose, it would be desirable to provide apparatus and methods for quickly and effectively coupling the graft material to the tissue.
Various tacking devices have been used to couple a graft to tissue during hernia procedures. Some of the tacking devices comprise spiral or threaded members. In some cases, a screwdriver may engage a head region of the tacking device to screw the tacking device into the tissue, or alternative, loosen its engagement with the tissue. However, such tacking devices comprise rigid members having a fixed profile, which therefore requires a relatively large delivery device and incision. Moreover, the inventor has discovered that tacking devices may permit slipping of the graft member relative to the tissue, and the head region may significantly protrude into a body space and inadvertently snag on organs such as the intestines, causing surgical complications.